International Journal of Research in Medical Sciences
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Role of body mass index and waist circumference in predicting of gestational diabetes mellitus, pregnancy induced hypertension and adverse pregnancy outcome amongst obese women
Get PDFBackground: Risks to the pregnant women due to obesity during pregnancy include gestational diabetes, hypertensive disorders of pregnancy, sepsis, venous thromboembolism, stillbirth, preterm delivery, large for gestational age infant, cardiometabolic disease and obstructive sleep apnea. For the fetus, the risks include congenital anomalies, fetal growth restriction, macrosomia, prematurity, anomalies, and other adverse clinical outcomes. Thus, the aim of the present study was to the test hypothesis that waist circumference was as good as body mass index (BMI) to identify women at risk of obesity related complications during pregnancy.
Methods: 200 pregnant women in first trimester of pregnancy coming in antenatal outpatient department (OPD) of government medical college, Amritsar were recruited from October 2022 to March 2024. Patients were classified as obese/non obese as per Asian ethnicity specific threshold of waist circumference according to which waist circumference ≥80 cm is obese. Based on BMI women were classified as underweight, overweight and obesity. Overweight is a BMI ≥25 kg/m2; and obesity is a BMI ≥30 kg/m2. Pregnancies were followed up throughout pregnancy and final outcome were recorded and compared.
Results: Of the 200 participants, 13.5% were overweight, 4% were obese, another 10.5% were underweight and rest 72% had normal BMI. On the other hand, as per waist circumference the prevalence of obesity was 20% (waist circumference ≥80 cm), which was more than the combined prevalence (17.5%) of overweight (BMI=25-29.9) and obese (BMI ≥30) as per BMI. Both BMI >25 kg/m2 and waist circumference ≥80 cm are associated with increased odds of preterm labour gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), obstructed labour and SSI. It was statistically significant for GDM and HDP. Also, amongst women with >30 kg/m2 (obese), the odds of abortion and antepartum haemorrhage (APH) were increased significantly.
Conclusions: Both high BMI and waist circumference/80 cm are significant risk factors for development of GDM and hypertension. Maternal obesity defined by BMI >30 is a significant risk factor for abortion and APH. These two complications are not predicted by waist circumference
Post-traumatic splenic cyst presenting as epidermoid cyst in spleen: an unusual presentation
Get PDFEpidermoid splenic cysts are very rare among primary splenic cysts. The histologic findings show cyst wall lined by stratified squamous epithelium, various theories have emerged regarding the origin of cysts, however controversies still exist. We report a case of young adult male in his 20s presenting with left upper abdominal quadrant pain and distention treated with open surgical procedure. Histopathology and immunohistochemistry findings further confirming the diagnosis as epidermoid splenic cyst. The case is unique in its association with history of trauma and development of true cyst
Innovative use of autologous fat grafting and regenerative therapies in the surgical management of dermatological scarring disorders: a systematic review of functional and aesthetic outcomes
Get PDFA systematic strategy was adopted to evaluate efficacy of autologous fat grafting and regenerative therapies such as platelet-rich plasma (PRP) or stromal vascular fraction (SVF) for the management of dermatological scarring disorders. In methodology, selected databases are PubMed, Scopus, Web of Science and Cochrane Library so total of 25 studies were selected involving 2,130 patients with hypertrophic, keloid, or atrophic scars. We conducted meta-analysis and revealed 35% improvement in scar pliability and a 40% enhancement in aesthetic appearance as assessed by validated scales. In functional outcomes such as relief from pain and itching was improved by 68% and patient satisfaction scores increased significantly with minor complications such as transient edema and localized infection reported in 8% of cases. Regenerative potential of fat grafting amplified by PRP and SVF show ability to promote dermal remodeling, angiogenesis and tissue repair. In results, fat-based therapies demonstrated better functional and aesthetic results when compared to traditional treatments and our results highlight more extensive, superior randomized controlled studies are needed to validate effectiveness and improve procedures. We illustrated how autologous fat grafting and regeneration techniques can improve patient satisfaction and results in dermatological scarring
Occupational therapy and rehabilitation: fostering mental resilience and professional re-entry
Get PDFBackground: Occupational therapy (OT) plays a critical role in rehabilitation by addressing both physical and psychological challenges, fostering mental resilience, and supporting professional re-entry for individuals recovering from disabilities or illnesses. This study evaluated the impact of OT on mental resilience and professional re-entry among individuals undergoing rehabilitation at the Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka, Bangladesh.
Methods: A cross-sectional study was conducted from August 2023 to July 2024, involving 150 participants recruited through purposive sampling. Standardized tools were used to assess mental resilience (resilience scale), employment readiness, self-efficacy, and satisfaction with OT services. Data were collected via structured questionnaires, interviews, and therapist records. Descriptive statistics summarized demographic data and therapy outcomes, while chi-square tests, paired t-tests, and logistic regression were used to analyse associations between OT interventions and mental resilience or professional re-entry.
Results: The study observed a significant improvement in mental resilience, with 65% of participants transitioning to moderate or high resilience levels post-therapy. Employment readiness increased by 40%, with 55% successfully re-entering the workforce. Quality of life scores improved in 78% of participants, and 85% expressed satisfaction with OT services. Regression analysis identified mental resilience, self-efficacy, and social support as strong predictors of successful professional re-entry (p<0.05).
Conclusions: OT interventions demonstrated a significant positive impact on mental resilience, quality of life, and employment outcomes. However, persistent barriers such as workplace accessibility and psychological challenges were noted. The findings underscore the need for integrated OT approaches to address these barriers and support holistic rehabilitation
Comparing prognostic value of lung ultrasound scores in predicting outcome of shock patients: an observational study
Get PDFBackground: Shock is a common causes of mortality in ICU. Several scoring systems have been developed to grade the severity of illness. These systems are moderately accurate in predicting survival. Several
scoring systems like APACHE, SOFA,SAPS, MODS etc have been used to risk stratify patients in ICU. The lung ultrasound score (LUSS) has been regarded as semi quantitative score to measure lung aeration loss. LUSS can be compared to scoring systems like acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA).
Methods: Our study was a prospective observational study. 100 patients who fulfilled the inclusion criteria for shock were included. Their APACHE II scores at admission and 24 hours were calculated. Similarly, SOFA scores at 24 and 48 hours post admission were calculated. Lung ultrasound examination was done at four regions of chest and scores noted. All the three scores were statistically analyzed for length of hospital stay, ICU stay, ventilator days and the outcome.
Results: Out of 100 cases satisfying the inclusion and exclusion, it was observed that high lung ultrasound scores were associated with increased mortality and number of days on mechanical ventilator. This association was statistically significant. Findings also correlated with high APACHE II and SOFA scores. All the above findings were statistically significant.
Conclusions: High lung ultrasound scores at admission were directly related with mortality and increased number of days on mechanical ventilator
Castleman’s disease: a diagnostic and therapeutic quandary, case series from a tertiary cancer centre in South
Get PDFCastleman’s disease (CD) is a rare, nonclonal lymphoproliferative disorder which was first described by Dr Benjamin Castleman. It can affect lymph nodes of any part of body, imitating both benign and malignant diseases. Co-occurrence and overlap in significant number of cases can be seen with lymphomas, amyloidosis and POEMS syndrome making its diagnosis and treatment challenging. We present a case series of four cases of CD, registered from January 2017 to August 2024.The mean age of presentation was 27 (13 - 42) years. There was male preponderance in the study with male to female ratio of 3:1. All the patients were immunocompetent. One patient belonged to pediatric age group where as other three were adults. Two patient was initially misdiagnosed out of which one received erroneous treatment for tuberculosis. In patients with multicentric CD, one was diagnosed with POEMS syndrome. Complete surgical excision was offered for unicentric CD. All the multicentric CD patients were treated with chemotherapy +/- immunotherapy. All the patients were alive on last follow up. Castleman’s disease is a rare disease having outcomes ranging from a benign to potentially fatal course. CD possesses a diagnostic challenge, as lack of specific features makes it difficult to distinguish it from other diseases often leading to inaccurate diagnosis and superfluous treatment. POEMS syndrome is frequently associated with CD. Surgical excision remains the mainstay treatment for unicentric CD, whereas patients with multicentric disease chemoimmunotherapy remains an acceptable option however owing to multiple complexities and association with other concomitant diseases, the overall prognosis of MCD remains abysmal.
The burden of hypertension in future doctors: a phase-wise cross-sectional study
Get PDFBackground: Hypertension is a growing concern in young adults, yet most studies focus on the elderly. Investigating its prevalence and risk factors in younger populations can enable timely interventions to prevent long-term complications. Medical students, facing academic stress and lifestyle changes, are particularly vulnerable. This study assessed hypertension prevalence and blood pressure variations across four academic phases.
Methods: A cross-sectional analytic study was conducted among 499 medical students aged 18–27 from four academic phases. Participants were selected through multi-stage sampling, and demographic, anthropometric, and clinical data were collected. Blood pressure was measured using an Omron HBP-1320 device, validated per ANSI/AAMI/ISO and ESH IP2 protocols, with classification based on AHA guidelines. Statistical analyses included ANOVA, chi-squared tests, and Spearman’s correlation.
Results: Median age increased from 20 years in phase 1 to 23 in phase 4. Mean BMI rose from 22.07±4.01 kg/m² to 23.51±4.67 kg/m². Systolic blood pressure increased across phases but was not statistically significant (p=0.223). Diastolic pressure rose significantly (p=0.011), with hypertension prevalence escalating from 19.5% to 41.2%. Males exhibited higher SBP, DBP, and pulse pressure (p<0.001). Positive correlations were observed between age, BMI, and blood pressure.
Conclusion: The study highlights a rising trend in stage 1 hypertension and diastolic pressure with academic progression, likely due to stress and lifestyle changes. Males had higher blood pressure levels. Early interventions targeting modifiable risk factors are essential to prevent long-term complications
Woman aged 42 years with Parkinson’s disease: a case study
Get PDFParkinson’s disease is also known as shaking palsy. It is a chronic, progressive neurodegenerative disease characterized by both motor and non-motor features. The prevalence of Parkinson disease is reported to be approximately 1% in people 60 years of age and older increases to 1% to 3% in the 80 plus age groups. Risk factors included oxidative stress, the formation of free radicals and environmental toxins. The most frequently reported symptoms in Parkinson disease are tremors in one hand, other symptoms showing slowness in movement, stiffness and loss of balance. Various diagnostic test performed to rule out Parkinson’s disease that is brain imaging, dopamine active transporter (DaT) scan, skin biopsy etc. Parkinson’s disease can be managed by combination of drugs like levodopa and monoamine oxidase (MAO)-B inhibitors
A rare case of posterior circulation stroke with anterior spinal artery involvement
Get PDFA 36 year old gentlemen with diabetes mellitus and systemic hypertension with acute onset giddiness with weakness of both upper limbs, developed over a period of several hours with bilateral triceps weakness, wrist dorsiflexion and palmar flexion weakness with no sensory disturbance and cerebellar signs. MRI brain showed left cerebellar infarct, left lateral medullary infarct, non- visualization of left vertebral artery, T2 hyper-intensity of cervical cord from 4th cervical segment to 8th cervical segment, multiple areas are affected because of left vertebral artery occlusion
Factors associated with the presence of microangiopathy in type 2 diabetics outpatients in Antananarivo, Madagascar, in 2023
Get PDFBackground: The microvascular complications of diabetes correspond to diabetic microangiopathy including retinopathy, nephropathy and neuropathy. Few data are available on diabetic microangiopathy in Madagascar. The aims of the present study were to determine the prevalence of microangiopathy and their associated factors in a population of type 2 diabetics seen as outpatients in the Endocrinology Department of Joseph Raseta Befelatanana Hospital, in Antananarivo, Madagascar.
Methods: Cross-sectional, descriptive and analytical study was conducted over a 6-month period. Retinopathy was diagnosed by specific abnormalities on fundus examination, nephropathy by albuminuria ≥30 mg/24h, and peripheral neuropathy by symmetrical distal sensory symptoms beginning in the lower limbs, a DN4 score ≥4/10 and/or impaired foot sensitivity.
Results: Of the one hundred type 2 diabetics included in the study, sixty-two (62%) had presented with one or more diabetic microangiopathy. Associated factors were diabetes duration ≥10 years (OR=3.28; 95% CI: 1.17-9.22), abdominal obesity (OR=1.72; 95% CI: 1.06-2.77) and HbA1c >10% (OR=3.72; 95% CI: 1.02-13.48). Albuminuria was significantly higher in type 2 diabetics with microangiopathy than in without (p<0.01) while estimated glomerular function rate was significantly lower (p=0.04).
Conclusions: Diabetic microangiopathy was frequent. Optimal management of hyperglycemia, obesity and associated cardiovascular risk factors is essential to avoid or limit their occurrence